Untreated Gleason grade progression on serial biopsies during prostate cancer active surveillance: Clinical course and pathological outcomes - Abstract

PURPOSE: To describe the outcomes of patients with low-risk localized prostate cancer who upgraded on a surveillance biopsy while on AS, and to evaluate whether delayed treatment was associated with adverse outcome.

MATERIALS AND METHODS: We included men with lower risk disease managed initially with AS, and upgraded to Gleason score ≥3+4. Patients' demographics and disease characteristics were compared. Kaplan-Meier curve was used to estimate the treatment-free probability stratified by initial upgrade (3+4 vs ≥4+3), Cox regression analysis to examine factors associated with treatment, and multivariate logistic regression analysis to evaluate the factors associated with adverse outcome at surgery.

RESULTS: The final cohort comprised 219 men, 150 (68%) upgraded to 3+4 and 69 (32%) to ≥4+3. Median time to upgrade was 23 months (IQR 11-49). 163 men (74%) sought treatment, the majority (69%) with radical prostatectomy (RP). The treatment-free survival at 5 years was 22% for 3+4 and 10% for ≥4+3 upgrade. Upgrade to ≥4+3, higher PSA density (PSAD) at diagnosis, and shorter time to initial upgrade were associated with treatment. At surgical pathology, 34% of cancers were downgraded while 6% were upgraded. Cancer volume at initial upgrade was associated with adverse pathological outcome at surgery (OR 3.33, 95% CI 1.19-9.29, p=0.02).

CONCLUSION: Following Gleason score upgrade, most patients elected treatment with RP. Among men who deferred definitive intervention, very few experienced additional upgrading. At RP, only 6% of men were upgraded further, and only tumor volume at initial upgrade was significantly associated with adverse pathological outcome.

Written by:
Hussein AA, Welty CJ, Ameli N, Cowan JE, Leapman M, Porten SP, Shinohara K, Carroll PR.   Are you the author?
Department of Urology and UCSF - Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco; Department of Urology, Cairo University, Egypt.  

Reference: J Urol. 2015 Jan 23. pii: S0022-5347(15)00167-6.
doi: 10.1016/j.juro.2015.01.077

PubMed Abstract
PMID: 25623742

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